• Declaration of commitment to end health inequity between Aboriginal and other Australians
• Bringing evidence to policy makers – the CRCAH Parliamentary Showcase
• ABCD Project Showcases Its Research to Federal Politicians
• CRCAH and CEITC welcome funding announcement on tobacco control
• Indigenous Tobacco Control Roundtable
• Apology starts restoration of hope and health - Professor Fiona Stanley
• COAG meets to target Aboriginal disadvantage
• National Indigenous health workforce training plan
• Urgent need for men’s health policy
• Meanwhile South Australia releases draft men’s health framework 
• New AIHW report - indicators of health status and determinants of health in rural, regional and remote Australia
• Population health congress 2008 - Volunteers and scholarships
• Nurses to meet
• New tool to assist drug and alcohol treatments
• Social Justice Report calls for modifications to NT intervention
• Loss of mastery and control undermines NT intervention – Researcher
• Honouring effective Aboriginal health partnerships – Standing Strong Together

• Study finds high rates of pneumonia amongst Aboriginal children
• Research into emergency presentations reveals an Indigenous health care gap in Victoria
• Evaluating a Qld Nutrition Campaign
• Aboriginal kidney research project leader sought
• Enhancing systems for protecting children – ARACY seeking researcher(s)

• New Discussion Paper - Racism Undermines Indigenous Health
• New Links person for Menzies
• Jargon brings drastic consequences – NT health educator
• Holding Men - Kanyirninpa and the health of Aboriginal men
• Images taken at the CRCAH Canberra Showcase

• Indigenous medical enrolments on the rise - UNSW
• Volunteering in Kintore – an experience of a lifetime
• CDU offers new Bachelor of Midwifery course
• PhD student an inspiration to others

   

Declaration of commitment to end health inequity between
Aboriginal and other Australians

In light of the signing of the historic declaration on closing the gap at the recent Indigenous Health Equality Summit the regular Gwalwa-Gai guest editorial is being replaced in this edition with the full Statement of Intent signed by Prime Minister Kevin Rudd……

Declaration of commitment to end health inequity between Aboriginal and other Australians

On March 13 the Australian Government co-signed the following declaration with a number of Aboriginal health organisations committing Australia to achieving health equity within a generation.
Immediately following the signing in Canberra the Government further announced two new policy initiatives aimed at meeting that commitment.
A $14.5 million investment to tackle high smoking rates amongst Aboriginal people and a $19 million investment in a National Indigenous Health Workforce Training Plan. Both initiatives are welcomed by the CRCAH as ones that we have advocated for strongly as necessary to achieving health equity for Indigenous Australians.

Indigenous Health Equality Summit
Statement of Intent

Prime Minister Kevin Rudd

This is a statement of intent – between the Government of Australia and the Aboriginal and Torres Strait Islander Peoples of Australia, supported by non-Indigenous Australians and Aboriginal and Torres Strait Islander and non-Indigenous health organizations – to work together to achieve equality in health status and life expectancy between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians by the year 2030.
We share a determination to close the fundamental divide between the health outcomes and life expectancy of the Aboriginal and Torres Strait Islander peoples of Australia and non-Indigenous Australians.
We are committed to ensuring that Aboriginal and Torres Strait Islander peoples have equal life chances to all other Australians.
We are committed to working towards ensuring Aboriginal and Torres Strait Islander peoples have access to health services that are equal in standard to those enjoyed by other Australians, and enjoy living conditions that support their social, emotional and cultural well-being.
We recognise that specific measures are needed to improve Aboriginal and Torres Strait Islander peoples’ access to health services. Crucial to ensuring equal access to health services is ensuring that Aboriginal and Torres Strait Islander peoples are actively involved in the design, delivery, and control of these services.

Accordingly we commit:

• To developing a comprehensive, long-term plan of action, that is targeted to need, evidence-based and capable of addressing the existing inequities
• in health services, in order to achieve equality of health status and life expectancy between Aboriginal and Torres Strait Islander peoples and non- Indigenous Australians by 2030.
• To ensuring primary health care services and health infrastructure for Aboriginal and Torres Strait Islander peoples which are capable of bridging the gap in health standards by 2018.
• To ensuring the full participation of Aboriginal and Torres Strait Islander peoples and their representative bodies in all aspects of addressing their health needs.
• To working collectively to systematically address the social determinants that impact on achieving health equality for Aboriginal and Torres Strait Islander peoples.
• To building on the evidence base and supporting what works in Aboriginal and Torres Strait Islander health, and relevant international experience.
• To supporting and developing Aboriginal and Torres Strait Islander community-controlled health services in urban, rural and remote areas in order to achieve lasting improvements in Aboriginal and Torres Strait Islander health and wellbeing.
• To achieving improved access to, and outcomes from, mainstream services for Aboriginal and Torres Strait Islander peoples.
• To respect and promote the rights of Aboriginal and Torres Strait Islander peoples, including by ensuring that health services are available, appropriate, accessible, affordable, and of good quality.
• To measure, monitor, and report on our joint efforts, in accordance with benchmarks and targets, to ensure that we are progressively realising our shared ambitions.

Signed by:

• the Australian Government
• National Aboriginal Community Controlled Health Organisation
• Congress of Aboriginal and Torres Strait Islander Nurses
• Australian Indigenous Doctors Association
• Indigenous Dentists Association of Australia
• Aboriginal and Torres Strait Islander Social Justice Commissioner,
  Human Rights and Equal Opportunity Commission

Bringing evidence to policy makers – the CRCAH Parliamentary Showcase

The inaugural CRCAH Parliamentary Showcase saw Australia’s politicians, their advisers and senior policy makers and health planners told of the very latest research initiatives and evidence-based programs that are having a positive impact on the health of Aboriginal people.

The showcase, a response to Prime Minister Kevin Rudd’s pledge to develop “evidence-based policy not just…grand statements”, was opened by Health Minister Nicola Roxon (click here to view speech) who spoke enthusiastically about the work of the CRCAH and the opportunities for effective partnership between the Rudd Government and the Aboriginal health research sector.

“Your work will put the nation on a stronger footing to (closing the gap),” she told CRCAH Chair Pat Anderson who welcomed her to the Showcase. “We understand that a solid evidence base, built on good quality research, is absolutely critical if we’re going to achieve this goal – which is of course why the work of the CRC is so important,” the Minister said in her opening speech.

The audience was presented with evidence of what works in Aboriginal health; of what are the continuing challenges and of what the gaps in knowledge are by researchers from University of Queensland, Menzies School of Health Research, Charles Darwin University and the University of Melbourne.

Mick Gooda gave a summary of the CRCAH work and the challenges to ensure greater Aboriginal control of the research agenda and to improve on research uptake by policy makers. Mick presented the audience with information about the CRCAH research development process.

He told the showcase that the quality of research can only be enhanced by decisive Aboriginal control of the process.

Mick was followed by CRCAH Research Director Professor Ian Anderson who spoke about the importance of evidence-based research in underpinning health initiatives.

Indigenous tobacco control specialist, Viki Briggs, from the Centre for Excellence in Indigenous Tobacco Control presented data on Aboriginal smoking rates.

Viki argued strongly that reducing Aboriginal smoking rates is a critical step in efforts to close the health gap between Aboriginal and other Australians

The rest of the program was devoted to research findings that are already yielding concrete strategies to improve Indigenous health.

Dr Ross Bailie and Michelle Dowden from the Audit and Best Practice in Chronic Diseases project presented their work which has already had a major impact on improving prevention and management of chronic diseases across Australia

Professor Cindy Shannon from the University of Queensland gave details of the Learning from Action project which used an action learning and research approach to develop understanding of management practices in Aboriginal Health Services and built knowledge and skills and a research agenda within the Aboriginal community-controlled health sector.

The team from the successful NT-based Parenting Support Interventions for Indigenous Families: Let’s Start Extension presented their work which is already helping to improve developmental outcomes in Aboriginal children through support of both parents and children.

CEO Mick Gooda told Gwalwa-Gai that he was serious about keeping the Rudd Government to its promise for evidence based policy creation.

“The CRCAH and its predecessor have spent over a decade investigating how best to deliver health services to Indigenous people and how to remove impediments to Indigenous people accessing the help they need,” Mr Gooda said.

“This is the sort of information the Government needs to hear.”
For more information: www.crcah.org.au/events/parliamentary_showcase.html

To view images from the Canberra Showcase please Click here

ABCD Project Showcases Its Research to Federal Politicians

A practical health research project presented at the recent Aboriginal Health’s Parliamentary Showcase of Aboriginal Health Research, hosted by the Cooperative Research Centre for Aboriginal Health (CRCAH), was the ABCD Project, or the Audit and Best Practice in Chronic Disease Project.

In their presentation, ABCD researchers Ross Bailie and Michelle Dowden highlighted to federal politicians, their advisers and senior bureaucrats some of the project’s successes in the prevention and management of chronic diseases across Australia, based on continuous quality improvement (CQI) processes.

Ross Bailie is a Senior Principal Research Fellow at the Menzies School of Health Research in Darwin and a Program Leader for the CRCAH Comprehensive Primary Care, Health Systems and Workforce Program. Michelle Dowden is a registered nurse and midwife with extensive remote area nurse experience, both as a manager and in leading community health education programs. She has a Graduate Certificate in Public Health and is currently enrolled in a Master of Public Health.

According to the two researchers, the ABCD project aims to improve health outcomes for Indigenous communities by assisting Indigenous primary health care centres to improve their systems for delivery of best practice care.

The project initially started with 12 participating health centres in the Top End of Australia focusing on chronic disease. But now there are more than more than 50 Indigenous primary health care centres across the Northern Territory, Western Australia, New South Wales and north Queensland enrolled in the program targeting a wider range of primary health care priorities.

“Uptake of the CQI processes in Indigenous primary health care settings in Australia has been shown to have a positive impact on health care service quality, viability and long-term sustainability - and is gaining momentum,” Ross Bailie and Michelle Dowden said.

Based on their experience with Indigenous quality improvement and related initiatives over the past ten years, they outlined in their presentation what was needed to embed the successful features of these efforts into long-term sustainable practice, including:

• More consultative approach to performance measurement and monitoring;
• The increasingly wide acceptance of practitioner-led best practice guidelines;
• Recognition of the potential to use CQI as a strategy for guideline implementation;
• External facilitation support;
• A focus on recognised priorities;
• Flexibility in implementation;
• A focus on system improvement; and
• The congruence of modern CQI principles with Indigenous health research values and ethics.

The two researchers acknowledge that the research/service/policy partnership established through the CRCAH has been critical to the ongoing success of the ABCD Project.  

The ABCD Project team recently has published a training kit, to assist Indigenous health workers and other medical practitioners at ABCD-enrolled health centres to implement CQI-based health care. ABCD Project Resource Kit: A Training Resource to Support a Structured Quality Improvement Systems Approach to Indigenous Primary Health Care, authored by Robyn Williams, Michelle Dowden, Kate Lonergan, Lyn O’Donoghue, and Ross Bailie, is now available on the ABCD website: www.abcdproject.org.au

CRCAH and CEITC welcome funding announcement on tobacco control

The Centre for Excellence in Indigenous Tobacco Control (CEITC) and the CRCAH have been effectively collaborating on the urgent need for improved Aboriginal tobacco control strategies.

As part of this collaboration the two organisations produced a joint policy brief (Targeting Indigenous Australians’ smoking rates) and CEITC delivered a comprehensive summary of Indigenous tobacco use at the CRCAH’s recent Parliamentary Showcase. 

The CRCAH and CEITC were therefore delighted the week after the showcase when the Prime Minister, the Health Minister and the Minister for Indigenous Affairs announced funding of $14.5 million to curb high smoking rates among Aboriginal people.  A media release (New smoking initiatives a good start to closing the gap) was issued to respond. 

CEITC and the CRCAH will hold a national Indigenous tobacco control roundtable in Brisbane in late May (see story elsewhere in this Gwalwa-Gai).

Download a copy of:

• Fact Sheet
• Policy Brief 

Or for further information visit: www.crcah.org.au/research/tobacco_control.html

Indigenous Tobacco Control Roundtable

The Centre for Excellence in Indigenous Tobacco Control (CEITC) and the CRCAH will jointly host a national Indigenous tobacco control roundtable in Brisbane on May 23 to prioritise gaps in research within Indigenous tobacco control.

CEITC, which is based within the Onemda VicHealth Koori Health Unit at The University of Melbourne, seeks to reduce ill-health and mortality associated with tobacco smoking among Aboriginal and Torres Strait Islander people by:

• Building effective programs in Indigenous tobacco control;
• Consulting widely to ensure that the community has an opportunity to inform Indigenous tobacco control policy; and
• Taking a leading role in evidence-based policy reform.

Viki Briggs presenting at the CRCAH’s recent parliamentary Showcase

The roundtable will bring together Indigenous health experts, community leaders, policy makers and researchers to come up with a research plan to ensure that efforts to reduce Indigenous tobacco use and its associated health impacts are evidence-based.

Presenting research findings at the Parliamentary Showcase in Canberra on 20 March CEITC’s manager Viki Briggs, told the assembled politicians, political advisers and bureaucrats that: “Good work has been carried out by individuals and organisations around Australia to help Indigenous people quit smoking. Because this work is spread out, opportunities for others to learn from this experience can be limited. CEITC’s aim is to encourage the sharing of knowledge and resources and to provide networks through which this learning can be achieved.”

For further details about the roundtable, please contact Anke van der Sterren on Tel: 03 8344 0892 or
Email ankevd@unimelb.edu.au You can also visit CEITC’s website at www.ceitc.org.au

Apology starts restoration of hope and health - Professor Fiona Stanley

Leading Australian paediatrician and former Australian of the Year Professor Fiona Stanley says the recent Federal Government apology for the forced removal of Aboriginal children from their families is fundamental to beginning a process of reconciliation and healing.

COAG meets to target Aboriginal disadvantage

Australia’s federal, state and local governments will implement 23 measures across health, education, affordable housing and water supply to close the gap on Indigenous disadvantage.

At its 21st meeting held in Adelaide in March, the Council of Australian Governments (COAG) agreed to:

• Half the gap in Indigenous employment outcomes within a decade; and
• Provide at least 48,000 dental services to Indigenous people over four years.

It also agreed to target the needs of Indigenous Australians through:

• The Transition Care initiative (a collaboration between the aged care sector, public hospitals and the community to improve the options for older people);
• The elective surgery waiting list reduction plan;
• The “Place to Call Home” program for homeless people; and
• Specific high-level education targets on Indigenous educational attainment and the training sector.

Highlighting the urgency of Indigenous affairs, COAG has asked its Indigenous Reform Working Group to bring forward to the July COAG meeting the reform proposals on Indigenous Early Childhood Development. At this meeting, COAG will also consider an assessment of water supply in remote communities, including Indigenous communities.

COAG also asked its Working Group to bring forward sustainable reform proposals no later than the COAG meeting in October on:

• Basic protective security from violence for Indigenous parents and children;
• Remote service delivery and workforce planning; and
• Economic participation and active welfare.

Meanwhile, in another COAG health initiative the Australian Government announced that it will inject an additional $500 million into public hospitals, fund up to 50,000 new health training places, and set up a national registration system for health professionals.
The Rudd Government agreed to commit an immediate allocation of $1 billion to relieve pressure for 2008-09 on public hospitals.  “This $1 billion is made up of the indexation of the previous Commonwealth allocation for 2007-08 plus a further $500 million in additional new money,” COAG said in its 26 March communiqué.

Overall, this increase in Commonwealth funding for public hospitals in the next financial year (2008-09) brings the total allocation under the Australian Healthcare Agreement to just over $10.2 billion, or about a 10 per cent increase in one year. “This decision reverses the national trend of Commonwealth cutbacks to hospital funding over the past five years,” COAG said in its communiqué. 

“COAG agreed that in developing the new health care agreement (expected to be signed in December 2008, with a commencement date for the new funding arrangements of 1 July 2009) there would be a review of the indexation formulas for the years ahead.” 
Small and regional hospital services, which would include Indigenous health services, are likely to escape any negative effects of the new health care agreement. “COAG agreed for jurisdictions, as appropriate, to move to a more nationally-consistent approach to activity-based funding for services provided in public hospitals – but one which also reflects the Community Service Obligations required for the maintenance of small and regional hospital services.”
In its communiqué, COAG also agreed to “the introduction of a national registration and accreditation system for health professionals and steps to address health workforce skills shortages.”
It is looking at funding up to 50,000 new health training places, including vocationally-trained nursing, emergency care and allied health occupations. Currently, there are critical shortages in dentistry, nursing and Indigenous health. A decision on this is likely at COAG’s July 2008 meeting.

National Indigenous health workforce training plan

The Australian Government has announced an investment of $19 million over three years to build the Aboriginal health workforce.

The establishment of the National Indigenous Health Workforce Training Plan was announced at the recent Indigenous Health Equality Summit.

The CRCAH has welcomed the plan after long advocating the need for increasing the Aboriginal health workforce as critical to improving health services and increasing Aboriginal life expectancy.

In a media statement issued just prior to last year’s federal election CRCAH CEO Mick Gooda spoke of “mounting research evidence that increased Aboriginal health expertise and control of health services, actually increases positive health outcomes.”

“It is essential that both major parties commit to maintaining the delivery of primary health care and building the capacity of Aboriginal people themselves to deliver effective services,” Mick Gooda said. ”Now is not the time to change course in Aboriginal health policy but to increase investment in training Aboriginal health practitioners.”

Increased Aboriginal participation in the health workforce is critical to closing the health inequity gap

The workforce training initiative will:

• Support the Australian Indigenous Doctors Association to expand its work of mentoring and networking young Indigenous doctors;
• Support the Congress of Aboriginal and Torres Strait Islander Indigenous Nurses to expand its network of mentoring Indigenous nurses;
• Support the Aboriginal community controlled health sector to encourage Indigenous people and students to join the Indigenous health workforce;
• Provide additional training opportunities for Aboriginal Health Workers, and support for the establishment of a National Aboriginal Health Worker Association; and
• Support the Leaders in Indigenous Medical Education Network to ensure that Indigenous health is expanded into the curriculum in medical, allied health and nursing schools.

Meanwhile South Australia releases draft men’s health framework 

South Australian Health Minister John Hill has released a draft of the South Australian Men’s Health Strategic Framework (2007 – 2012) on the department’s website.

According to the Minister the Framework will provide a common set of principles and a co-ordinated direction for services and research in men’s health.  “It is well known that many men typically wait too long to access health services,” Minister Hill said. 

“Evidence also shows that the leading causes of death, illnesses, and injuries are largely preventable. It seems many men don’t like to talk about their health and figures prove that men still visit their GP far less than women. I want to urge men to think of their families, their children and their partners, and to think what impact their illness would have on their families.

“We know that among the top causes of loss of life years due to premature death and illness in men in South Australia for 2001-03 were ischemic heart disease, strokes and lung cancer.  

“Obesity is also another major health issue for Australian men. The simple fact is that Australian men need to take more time in looking after their health and I hope the new Framework will at least encourage them to give their health more thought.”

Among the main objectives of the Framework include is a commitment to support for policies and programmes which address Aboriginal male health.

The Framework commits health services to providing services and programs that:

• Recognise the historical and ongoing social, cultural, spiritual and economic impacts of colonisation on the health and well being of Aboriginal men, their sense of self and their relationship to their families and communities.
• Recognise the need for the health system to provide services that are culturally safe and respectful and that support the role of Aboriginal males in traditional and contemporary cultures.

The South Australian Men’s Health Strategic Framework (2008-2012) draft can be viewed at : www.health.sa.gov.au/Default.aspx?tabid=62

New AIHW report - indicators of health status and determinants of health in rural, regional and remote Australia

Aboriginal people living in rural and remote areas were more likely to experience food insecurity and males were more likely to demonstrate high to very high levels of psychological distress according to a new report from the Australian Institute of Health and Welfare.

In 2003, a Rural Health Information Framework was established to aid the understanding of, and to monitor the health of regional and remote populations. Indicators were identified across three areas:

• health status and outcomes;
• health determinants; and
• health system performance.

This report is the second in an AIHW series, which reports on indicators of health from a regional and remote perspective. Indicators of health status and determinants of health are published here. A complementary report focusing on indicators of health system performance is scheduled for publication in mid–2008.

Key findings

• Rates of self-reported diabetes, cerebrovascular disease, coronary heart disease, depression, and anxiety were generally similar for those living in Major Cities and those living in regional and remote areas.
• Compared with those living in Major Cities, the incidence of cancer was slightly higher for those living in regional areas and slightly lower for those living in Very Remote areas in the two years 2001–03.
• People in regional and remote areas were more likely than those in Major Cities to report an acute or chronic injury, to drink alcohol in quantities risking harm in the short term, or to be overweight or obese.
• Compared with people living in Major Cities, people living in regional and remote areas were less likely to consume low-fat or skim milk or to consume the recommended two serves of fruit per day. However, they were more likely to consume four or more serves of vegetables per day.
• Lower birthweights outside Major Cities were particularly marked for teenage mothers (those aged younger than 20 years).
• Life expectancy decreases with increasing remoteness. Compared with Major Cities, the life expectancy in regional areas is 1–2 years lower and in remote areas is up to 7 years lower.
• Compared with those in Major Cities, people in regional and remote areas were less likely to report very good or excellent health.
• Across all geographic areas, the health of Aboriginal and Torres Strait Islander peoples was generally worse than non-Indigenous Australians. The higher proportion of Indigenous Australians in remote area populations contributes to, but does not completely account for, the generally poorer health of people living in remote areas.

Other findings

• Indigenous Australians were generally less likely to report consumption of two serves of fruit and four or more serves of vegetables per day and more likely to report food insecurity than all people in Major Cities.
• Compared with their Major City counterparts, males were more likely to show high to very high levels of psychological distress in Outer Regional and remote areas.
• Compared with their Major City counterparts, females had higher fertility rates in all regional and remote areas.

Report available from: www.aihw.gov.au/publications/index.cfm/title/10519

Other recent AIHW reports at www.aihw.gov.au include:

• Key national indicators of children's health, development and wellbeing: indicator framework of 'A picture of Australia's children 2009' (1 April 2008) (publication)
• Diabetes: Australian facts 2008 (28 March 2008) (media release and publication)
• Alcohol and other drug treatment services NMDS specifications 2008-09: data dictionary, collection guidelines and validation processes (25 March 2008) (publication)

Population health congress 2008 - Volunteers and scholarships

The Public Health Association of Australia is offering ten scholarships (worth up to $2,500) for Indigenous people to attend the Population Health Congress 2008.

Entitled, A GLOBAL WORLD – Practical Action for Health and Well-being the Congress will be held in Brisbane from July 6 – 9.

In addition 12 volunteer places will be made available to attend the Congress.

To view the criteria and application forms for both Volunteers and Indigenous Scholarships
Click Here

Nurses to meet

The tenth annual conference of Aboriginal and Torres Strait Islander nurses will take place in Adelaide from 10 – 12 September.

The 2008 Congress of Aboriginal and Torres Strait Islander Nurses (CATSIN)
Annual Conference, themed CATSIN Dreaming, is now calling for abstract submissions of no more than 200 words.

Abstract submissions must contain the following information:

• Title of presentation
• Presenters/authors (please indicate if the author/s differ from the presenter/s)
• Contact details (including at least one telephone number, address and email address).

Closing date for submissions is 30th May 2008 and they should be forwarded (electronic submissions are preferred) to:

Roslyn Lockhart:
Email: lockharr@bigpond.net.au
Phone/fax: (03) 5886 0505

Conference flier & registration forms available on: www.indiginet.com.au/catsin/

New tool to assist drug and alcohol treatments

A collaboration between three Queensland drug and alcohol agencies has resulted in the development of the Indigenous Risk Impact Screen and Brief Intervention (IRIS).

Alcohol, Tobacco and Other Drug Services (ATODS), the Centre for Drug and Alcohol Studies (CDAS), and the Prince Charles Hospital Health Service District Alcohol and Drug Service developed IRIS, a screening instrument and brief intervention, to meet the specific needs of Aboriginal and Torres Strait Islander communities in Queensland.

According to Queensland Health the assessments are systematically administered and risks (in terms of drug use and mental health) and can now be addressed in a culturally appropriate way.
IRIS was developed in response to a number of recommendations from both national and state reports where alcohol and other drugs are the cause and symptom for health and environmental factors affecting the lives of Aboriginal and Torres Strait Islander peoples. The risk screen seeks to:

• provide timely advice to clients and family about the extent and nature of the substance misuse and possible interventions and treatment pathways
• enable both Aboriginal and Torres Strait Islander and mainstream substance misuse and health agencies to better target their response to client needs by establishing collaborative networks that will ensure better use of resources
• provide all Aboriginal and Torres Strait Islander Community Workers with support by establishing and building collaborative networks that will assist in addressing the alcohol and other drug issues that affect the Aboriginal and Torres Strait Islander community
• ensure sustainability of the tool by its validation and implementation into alcohol and drug training programs across academic institutions.

For more information:          
Dr Carla Schlesinger, Alcohol and Drug Service
The Prince Charles Hospital Health Service District
Tel: 07-3238 4065
Email: carla_schlesinger@health.qld.gov.au

Social Justice Report calls for modifications to NT intervention

The 2007 Social Justice Report 2007 has called on the Federal Government to modify the Northern Territory intervention legislation to ensure maximum protection of children from abuse without racially discriminating against Indigenous people.

The report, produced annually by the Human Rights & Equal Opportunity Commission through the Aboriginal and Torres Strait Islander Social Justice Commissioner, Mr Tom Calma, considers the impact of government activity on the exercise and enjoyment of Indigenous people’s human rights.

“In putting forth this plan, I note that the new federal government has emphasised the importance of ensuring that the NT intervention is consistent with Australia’s human rights obligations,” Mr Calma said.

“But the fact is, as long as the NT intervention allows the conduct of racially discriminatory actions it will lack legitimacy among Aboriginal people and communities as well as the broader Australian society,” he said.

“Over the last 18 months we’ve seen sustained media coverage of child abuse and family violence, but we’ve rarely seen or heard how Indigenous people and communities across Australia are taking positive steps to respond to this violence, abuse and neglect.

“I have provided 19 case studies in the Social Justice Report 2007 as evidence of what can be achieved in the fight against child abuse and family violence in Indigenous communities when there is true engagement with Indigenous people.

“Sometimes these steps were taken because communities felt a need to take action themselves and others developed through formal and informal partnerships with individual government agencies, non-government organisations, the courts or police.

“But most importantly, every single one of them is striving to make a lasting difference and they are initiatives lead by Indigenous people.”

The Social Justice Report 2007 also identifies a number of other specific concerns about the NT intervention such as: consistency of the income management regime with the rights to social security; privacy and non-discrimination; the consistency of the alcohol management regime with the right of non-discrimination; and the absence of effective participation of Indigenous peoples in decision making that affects them.

The report outlines a Ten Point Action Plan for modifying the NT intervention, which includes:

Action 1: Restore all rights to procedural fairness and external merits review under the NT intervention legislation.
Action 2: Reinstate protections against racial discrimination in the operation of the NT intervention legislation.
Action 3: Amend or remove the provisions that declare that the legislation constitutes a ‘special measure’.
Action 4: Reinstate protections against discrimination in the Northern Territory and Queensland.
Action 5: Require consent to be obtained in the management of Indigenous property and amend the legislation to confirm the guarantee of just terms compensation.
Action 6: Reinstate the CDEP program and review the operation of the income management scheme so that it is consistent with human rights.
Action 7: Review the operation and effectiveness of the alcohol management schemes under the intervention legislation.
Action 8: Ensure the effective participation of Indigenous peoples in all aspects of the intervention – Developing Community Partnership Agreements.
Action 9: Set a timetable for the transition from an ‘emergency’ intervention to a community development plan.
Action 10: Ensure stringent monitoring and review processes.

To view the Social Justice Report 2007: www.humanrights.gov.au/social_justice/sj_report/sjreport07/

Loss of mastery and control undermines NT intervention – Researcher

The following article by Professor Kerin O’Dea is reproduced from On Line Opinion. Professor O’Dea is a Professorial Fellow at the University of Melbourne, Department of Medicine (St Vincent’s Hospital) and was Director of the Menzies School of Health Research from 2000-2005.

In the context of the current interventions in the Northern Territory by the Australian Government, it is important to understand how social factors can directly impact on health.

Twenty-five years ago I was privileged to be part of a study with the Mowanjum community based near Derby in the north of Western Australia. We looked at the impact of temporary reversion to traditional hunter gatherer lifestyle on the health of a group of middle-aged people with diabetes. These people had retained the knowledge and ability to live as hunter-gatherers - which is the reason this study was possible.

After only seven weeks there was a profound improvement in all of the metabolic abnormalities of diabetes and all the risk markers for heart disease.

But in addition, I was struck by changes which I could not measure at the time - wonderful changes in people’s demeanour. When the people in this study went back to their own land - even for only a few weeks - they changed greatly. They were confident, competent and articulate practitioners of their traditional lifestyle. They seemed to physically grow in stature! What I was witnessing was the dramatically positive impact of mastery and control.

The intervention in the NT risks producing the opposite - the loss of any sense of mastery and control - and the consequences of such disempowerment are likely to be dire indeed.

It is well-established that extreme poverty, characterised by poor education, poor nutrition, overcrowded and unsanitary living conditions, and inadequate medical care, impacts adversely on health outcomes and life expectancy. And this of course is very relevant to poor health outcomes in many Indigenous communities especially in remote Australia.

What is less well known is that it is not just the physical and environmental aspects of such poverty that are bad for your health, psychosocial factors are also very important.

The Whitehall Study - looking at the long term health of British civil servants - has examined the impact of employment grade on health outcome. All of these people are employed - so extreme poverty is excluded. However what they have observed is that, relative to those highest in the pecking order (the top administrators), those lowest in the hierarchy (unskilled messengers for example) had 2.5 times higher mortality after 10 years.
What was even more striking was that those in the professional and executive level (just below the top administrators) had significantly higher mortality than their bosses. And this despite being well-educated and highly paid - people such as lawyers and doctors.

So what is the explanation?

Some of the differential is explained by health-related behaviours - such as smoking, physical activity, alcohol consumption and diet. However, much of the gradient is explained by psychological factors. Indeed, it is now recognised that differences in some of the behavioural factors may also be secondary to these same psychological factors.
How is this relevant to what is going on in the NT?

One’s socioeconomic position in society is linked to a number of psychological factors impacting on health including depression, psychosocial distress, individual and community level mastery, and disempowerment.

These factors are all interconnected. When people do not feel in control of their lives, there are a range of neuroendocrine responses - stress responses. Acute activation of our stress responses is important to our survival: “fight or flight”, activation of the immune system.

But chronic activation of our stress systems can be very counter-productive.

“Allostatic load” is the term used to define the cumulative biological “cost” of accommodating stresses. The greater the stress burden, the greater the cost.

There is a direct relationship between socioeconomic status and allostatic load.

Apart from the impact on mental health, excessive stimulation of these stress pathways (the so-called hypothalamic pituitary axis, or HPA axis) has direct impact on our physical health: high blood pressure; increased appetite - and a desire for sweet and fatty foods; weight gain, and central obesity; infertility; increased risk of stroke heart disease, diabetes and some cancers.

If that is not enough, there is also evidence that Low Birth Weight may be linked to over activity of the HPA (stress axis) in pregnant women. And LBW itself is linked with increased risk of central obesity, diabetes and cardiovascular disease in adult life.

In this way it is possible to link disempowerment and lack of mastery with depression and psychosocial distress which in turn activate biological pathways to the chronic diseases which are occurring in epidemic proportions in Indigenous populations across Australia.

Dr Alex Brown, an Indigenous doctor based in Alice Springs, talks about the “broken-hearted”. The accompanying social dysfunction is a symptom, not an underlying cause.

What are potential interventions?

Certainly not interventions that further impoverish and disempower communities and individuals, which is what the removal of CDEP and appointment of administrators to remote Aboriginal communities does. The people who would most appreciate “real jobs” are the Indigenous people living in those communities. Many of the CDEP positions really should be remunerated as “real jobs”: rubbish removal and “caring for country” through the ranger programs are just two obvious examples.

The blanket removal of half of the remaining welfare payments implies that no Indigenous adult in a remote community can manage money or look after their children responsibly. And while it is critical that children attend school, threatening parents with loss of welfare payments has meant that schools are having to deal with a large influx of students (many of whom have only attended school rarely if at all in the past) without the needed additional classrooms and remedial teachers.

Rather than imposing short term simplistic interventions targeted at the end-stage symptoms, as a society we must seek to understand the underlying causes and commit long term to address them in a respectful partnership with Indigenous communities. Mutual obligation is a two-way street, conducted between equal partners.

Early intervention is needed - as upstream as possible. And yes, no one disagrees that children must be nurtured and protected: however, the way we intervene is absolutely critical.

It is encouraging that the new Australian government has committed to working closely with Indigenous organisations and the States and Territories to “Close the Gap” in Indigenous life expectancy, recognising that this will be a 20-30 year challenge.

What is needed is a comprehensive, long term, bipartisan “whole-of-government” commitment conducted in respectful partnership with the local communities and the states and territories - an Australian version of the Marshall Plan for the reconstruction of Europe after World War II - focusing on health, education, housing, and employment, and with a very significant and recurrent investment by the Australian Government to address the national disgrace of Indigenous disadvantage.
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Honouring effective Aboriginal health partnerships – Standing Strong Together

The Royal Australian College of General Practitioners (RACGP) is calling for nominations for the Standing Strong Together Award. This award was established in response to a recommendation from the third national face to face meeting of general practitioners and other people working in Aboriginal and Torres Strait Islander health in 2006. The award is made annually to a fellow or member of the RACGP and to an Aboriginal or Torres Strait Islander person who have worked in an effective partnership producing substantial outcomes in Aboriginal and Torres Strait Islander health.

To find out more about this award and how to nominate please visit www.racgp.org.au/standingstrongtogether

Information on other RACGP awards is accessible at the following link www.racgp.org.au/awards

Jargon brings drastic consequences – NT health educator

The Northern Territory-based Aboriginal Development Resource Services (ARDS) is calling for major changes to the way rheumatic heart disease is explained to Aboriginal people.
ARDS has recently launched a DVD which aims to convince health promotion workers, health educators and other health practitioners to use interpreters and stop using medical jargon when explaining issues around rheumatic fever and rheumatic heart disease to Aboriginal people, who have the world’s highest recorded mortality rate from the diseases.
The DVD is designed to improve the process of health education with patients who do not have English as a first language or a ' Western' biomedical worldview in their history.

The DVD demonstrates how to use the ' Rheumatic Heart Disease Story Telling Guide" which was developed by health professionals and Aboriginal language speakers working together to create a meaningful way to explain Rheumatic Heart Disease.
The DVD follows on from a major CRCAH-funded research project which investigated the impact of mis-communication between health practitioners and Aboriginal renal patients in the NT top-end.
The Sharing the True Stories project found that Aboriginal patients rarely understood the information that was presented to them by doctors and other health practitioners and recommended strongly the use of trained professional Aboriginal language interpreters.

ARDS says it hopes the DVD will be used throughout the NT so that acute rheumatic heart fever and rheumatic heart disease education is consistent and meaningful. ARDS says is important for health professionals to consider and reflect on how they provide on- going client education and it is hoped that this resource will assist with that process.
Alice Mitchell, ARDS health educator told Gwalwa-Gai that rheumatic heart disease is preventable and young Aboriginal people are dying unnecessarily.
“Not taking language and world view seriously can have drastic consequences and I have known a lot of young people who have died from this disease,” she said. “Most education for Yolgnu people is delivered entirely in English, which severely limits peoples’ ability to comprehend what’s going on.”
Alice was supported by her colleague, Paige Shreeve, health educator at Royal Darwin Hospital who said ARDS efforts were being welcomed by Aboriginal patients.  "Repeatedly people tell me that they are overwhelmingly grateful to hear this story in a language they can understand."

To read the Sharing the True Stories reports 1 & 2 go to:

• www.crcah.org.au/publications/downloads/STTS_stage1.pdf
  
  
• www.crcah.org.au/publications/downloads/STTS_stage2.pdf
  
  
• To find out more about ARDS: /www.ards.com.au/default.html

Holding Men - Kanyirninpa and the health of Aboriginal men

La Trobe University and CRCAH researcher Dr Brian McCoy has written an easily readable book that explores how Indigenous men understand their lives, their health and their culture.

To be published by Aboriginal Studies Press in mid-May this moving book uses conversations, stories and art, to show how Kimberley desert communities have a cultural value and relationship described as kanyirninpa or holding.

The author uses examples from Australian Rules football, petrol sniffing and imprisonment to reveal the possibilities for lasting improvements to men’s health based on kanyirninpa’s expression of deep and enduring cultural values and relationships.

While young Indigenous men’s lives remains vulnerable in a rapidly changing world, the author believes that an understanding of kanyirninpa (one of the key values that has sustained Aboriginal desert life for centuries) may provide the hope of change and better health for all. It also offers insights for all who wish to ‘grow up’ their young people.

CRCAH research Director and Deputy Head of the School of Population Health at University of Melbourne, Professor Ian Anderson, is among a number of prominent academics to endorse Dr McCoy’s new book.

“I was incredibly moved when I read Holding Men: Kanyirninpa and the health of Aboriginal men. It is rare for an academic work to so sensitively and poignantly capture the social realities for Aboriginal men growing up in contemporary desert communities. An intellectual work of considerable compassion, it grows from many decades of living and working in remote Australia and presents us with the intellectual apparatus to understand the dimension of the inter-generational processes which have the potential to both enable Aboriginal men to realize their potential as well as reproduce the social dislocation that is so fundamental to Aboriginal disadvantage.

“Petrol sniffing, Australian Rules football and imprisonment continue to impact the lives of desert men. Each one discloses the power, fragility and potential of kanyirninpa. Kanyirninpa is a concept that encapsulates both cultural authority and nurturing. It provides an insight into the ways in which Aboriginal men can be ‘held’ and strengthened through their journey to adulthood.”

AIATSIS, the CRCAH and the Lingiari Foundation will be launching Holding Men: Kanyirninpa and the health of Aboriginal men in Melbourne and the Kimberley in June.